1174583363 NPI number — UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION INC

Table of content: (NPI 1174583363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174583363 NPI number — UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174583363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7974 UW HEALTH COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53562-5531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-829-5270
Provider Business Mailing Address Fax Number:
608-833-0999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2418 BREWERY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSS PLAINS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53528-9470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-798-3344
Provider Business Practice Location Address Fax Number:
608-798-1369
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLANNERY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CAO & CFO
Authorized Official Telephone Number:
608-821-4223

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41724100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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